Firearms violence should be viewed as a public health safety issue

Two weeks before the Newtown Conn., shooting, I was at my doctor's office for an annual physical exam, answering questions on an intake survey. Questions like "Do you smoke? How much?" and "Do you wear the seat belt?"

And then one question stuck out. "Do you have any firearms in the house? Are they stored in a locked area?"

What business do my doctors have to ask me about my desire and acceptance to bear firearms? Or do they?

Politics aside, what does the medical and scientific literature say about gun ownership and gun control laws?

Each year, nearly the same number of people are killed in traffic accidents as are killed by firearms: 30,000. Sixty percent of the firearms deaths are suicides, and most of the remaining are homicides.

From statistical data, there is no evidence of an epidemic in shooting sprees, or an increase in the rate of deaths with firearms. But should we not attempt to lower this rate of death as we do with influenza, falls, heart disease and road traffic accidents?

Laws, education and technology along with solid scientific research have worked to decrease road traffic mortality (per mile driven) by 90 percent since the 1950s. For example, seat belt use has increased from 11 percent in 1981 to nearly 85 percent in 2010, and an estimated 255,000 lives have been saved since 1975, according to the Centers for Disease Control and Prevention (CDC).

Yet new threats like texting and driving have arisen, and others, such as drinking and driving, persist.

Like traffic accidents, firearms deaths are a public health problem. The underlying cause of firearms deaths is often mental illness including anxiety and depression. Also, the consequences of gun violence among survivors and in the community often lead to long-term psychological impact. Additionally, the prevention-based strategies to reduce gun violence are similar to other approaches to reduce domestic violence or child abuse.

So what do the scientific data on firearms show? In the early 1990s, studies published in the New England Journal of Medicine (NEJM) found that gun ownership leads to 2.7-fold increased risk of homicide and 4.8-fold increase risk of suicide. The studies were sponsored by the Centers for Disease Control and Prevention.

Yet the studies were controversial, often criticized by the group Gun Owners of America, which cited the article by Don Kates in the Tennessee Law Review. Kates stated that additional data from the NEJM study showed that "home guns homicide victims were killed using guns not kept in the victim's home."

Another study done by an independent task force evaluated laws with bans or restrictions on firearms and ammunition, waiting periods, and zero tolerance for firearms in schools. The study found that there was insufficient evidence to determine if these laws were effective or ineffective due to lack of research.

Here is where I believe the major problem lies. There is a lack of good studies and funding on the topic of gun violence, and there is a reason for this.

The 1990s NEJM study had major consequences among lawmakers. In 1996, the National Rifle Association championed an amendment to an appropriations bill, which removed $2.6 million dollars of funding from CDC's budget to look at the risks and benefits of firearms. In contrast, during this time we have spent $240 million a year on traffic safety research.

Over the past decade, the lack of research funding for firearms has subsequently put us all in the dark in even having a scientific answer to the simplest public health questions: Can the gun violence we are seeing in our streets, schools, workplaces and places of worship be tempered by legislation or social welfare interventions?

Lessons from other nations may help. After a 1996 massacre in Australia, a ban on certain rapid-fire long guns led to a near end in mass shooting over 14 years compared to some 13 mass shootings in the 18 years before the law. What do reputed U.S. researchers say about this? Can the impact be translated to America?

Richard Florida, a senior editor at the Atlantic, did his own research, putting together a map of deaths due to firearms in states with firearms laws. He found that "firearms deaths are significantly lower in states with stricter gun control legislations." States that ban assault weapons, require trigger locks and mandate safe storage requirements for guns had significantly lower gun-death rates.

Florida may or may not be correct in his analysis, yet these studies need to be done by trained scientists, statisticians and epidemiologists, not seasoned reporters.

When faced with an increasing number of cases of head injury and dementia among its players, the National Football League took a proactive approach to scientific research in finding ways to deter violent injuries rather than discouraging further funding for such studies.

So at this juncture, we need to accept firearms violence as a public health safety issue, provide for greater federally funded research, and ultimately, use the findings to help develop evidence-based legislation to protect us all. Then we can be certain whether it is appropriate for doctors to ask patients about firearms ownership and storage at their office visit and provide scientifically sound advice.